Table 3.
Primary studies evaluating the effects of medication for RA on body composition and cachexia.
| First author | Design | Participants | Intervention(s) | Comparator(s) | duration | Outcomes | Results |
|---|---|---|---|---|---|---|---|
| Marcora65 | Parallel RCT | N=26 patients with early RA | ETA (vials reconstituted with bacteriostatic water, injected subcutaneously twice/week) (n=12 ) | MTX per os (7.5 mg/week for a month, increased to a maximum of 15 mg/week for the 2ndmonth and 20 mg/week for the subsequent 4th month if deemed necessary ) (n=12 ) | 24 weeks | Body composition, physical function, disease activity, systemic inflammation, IGF levels | Approximately 44% of BW gained in the etanercept group was FFM, as compared to only 14% in the MTX arm. |
| Tournadre83 | CC | N=21 patients with active RA and 21 RA- free matched controls | TCZ (n=21 ) | No treatment (n=21 ) | 1 year | WC, BMI, BP, lipid profile, FPG, insulin, serum levels of adipokines and pancreatic/gastrointestinal hormones, and body composition (DXA) | Compared with controls, body composition was altered in RA with a decrease in total and appendicular LM, without any changes in BF. Among patients with RA, 28.6% had a skeletal muscle mass index below the cut-off for sarcopenia (4.8% of controls). After 1 year of treatment, a gain in BW was noted, without any changes in FM. An increase in LM was observed with a significant gain in appendicular LM and skeletal muscle mass index between 6–12 months of treatment. FM was decreased in the trunk/peripheral fat ratio, and increased in the subcutaneous adipose tissue. No changes were noted for WC, BP, FPG or atherogenic index. |
| Schultz85 | CT | N=11 non-diabetic patients with RD | TCZ (NOD) (n=11 ) | None | 3 months | HOMA-IR, serum levels for leptin, adiponectin, TG, LDL, HDL and Lp(a) | The HOMA-IR decreased significantly, leptin concentrations were not altered but adiponectin levels increased. Serum TG, LDL and HDL tended to be increased, whereas Lp(a) levels was lowered. |
| Toussirot84 | Open label CT | N=77 patients with active RA | TCZ IV 8 mg/kg monthly, as administered in daily practice, with the option to decrease TCZ dosage to 4 mg/kg at the rheumatologist’s discretion (n=77 ) | None | 1 year | BMI and anthropometry, lipid and metabolic parameters, serum adiponectin, leptin, resistin, ghrelin, body composition (DXA) | TCZ treatment was associated with an increase in adiponectin, especially at the onset of the treatment and induced a significant gain in LM, BMI and WC, while FM did not change. In addition, TCZ may have an anabolic impact on lean mass/skeletal muscle. |
| Fioravanti86 | CT | N=44 patients with active RA | IV TCZ (8 mg/kg) once every 4 weeks (n=20 ) | IV TCZ (8 mg/kg) once every 4 weeks, plus MTX (n=24 ) | 6 months | BMI, DAS28, HAQ | ESR, CRP, DAS28-ESR and HAQ improved in both arms. TC was increased and chemerin was decreased in both arms. |
| Chen76 | Non-randomized CT | N=30 patients with RA | Subcutaneous injections of ETA twice weekly (n=20 ) | Non-biological DMARDs (n=10 ) | 12 months | BW, BF, appetite rating, lipid profiles, gut hormones and leptin | ETA induced significant BW gain, hyperuricemia, decreased fasting plasma GIP levels, and loss of post-oral glucose suppression of plasma leptin concentration. Appetite score and serum lipid profiles did not change. |
| Toussirot79 | Parallel CT | N=8 patients with RA non-responders to DMARDs and 12 with AS | IFX (3 or 5 mg/kg in RA and AS, respectively) (n=3 ) | - ETA (50 mg/weekly) (n=7
) - ADA (40 mg every other week) (n=12 ) |
2 years | DXA, HAQ, ESR, CRP, DAS28, serum leptin, adiponectin, resistin, and ghrelin levels, body composition (DXA) | A gain in BMI and a tendency for BW gain, android and visceral fat increase was noted in patients with RA. |
| Serelis78 | Parallel CT | N=19 women with active RA | IFX (3 mg/kg) at weeks 0, 2, 6 and thereafter systematically every 8 weeks (n=10 ) | ADA (standard dose of 40 mg subcutaneously every 14 days) (n=9 ) | 1 year | BMI, body composition (DXA), adiponectin | No change in LBM, or FM and no difference was noted in lumbar spine BMD. Serum concentrations of adiponectin increased after 1 year of anti-TNF treatment. |
| Engvall77 | Parallel RCT | N=40 patients with early RA who failed MTX treatment (20 mg/week for 3 months) | MTX (20 mg/week) plus SSZ and hydroxychloroquine (n=22 ) | MTX treatment (20 mg/week) plus IFX (n=18 ) | 21 months | Body composition (DXA), BMD, leptin, adiponectin, apolipoproteins, IGF-1 | Patients treated with anti-TNF had a significant increase in fat mass compared to the other arm, despite similar reduction in disease activity. Both treatments prevented loss of muscle mass and bone. Leptin concentrations increased in both arms. No changes were recorded for apolipoproteins or IGF-1. The markers of bone resorption decreased at 12 months in both arms, without difference between them. |
| Konijn30 | Parallel RCT | N=108 prednisolone-naive patients with recent-onset RA | COBRA (prednisolone 60 mg/day, tapered to 7.5 mg/day in 6 weeks; MTX and SSZ) (n=54 ) | COBRA-light therapy (PSL 30 mg/day, tapered to 7.5 mg/day in 8 weeks, plus MTX) (n=54 ) | 26 weeks | Body composition (DXA) | There were no differences between the treatment groups. BW and FM were increased. The trunk/peripheral fat ratio and the proportional distribution of BW and FM remained stable over time. |
| Metsios24 | CC | N=20 patients with RA and N=12 healthy controls | anti-TNF treatment (n=20 ) | No treatment (n=12 ) | 12 weeks | BIA (Tanita BC-418-MA), TNF-α, physical activity, REE, DAS28 | There were no significant changes in FFM or BF. ESR, DAS28, HAQ, and TNF-α improved. |
ADA: adalimumab; AS: ankylosing spondylitis; BF: body fat; BIS: bioelectrical impedance spectroscopy; BMD: bone mineral density; BMI: body mass index; BP: blood pressure; BW: body weight; CC: case-control; COBRA: Combinatietherapie bij Reumatoide Artritis118; CT: clinical trial; DAS28: disease activity score (28 joints); DMARD: disease-modifying antirheumatic drug; DXA: dual x-ray absorptiometry; ESR: erythrocyte sedimentation rate; ETA: etanercept; FFM: fat-free mass; FM: fat mass; FPG: fasting plasma glucose; GIP: glucose-dependent insulinotropic polypeptide; HAQ: health assessment questionnaire; HDL: high-density lipoprotein; HOMA-IR: homeostatic model for insulin resistance; IFX: infliximab; IGF: insulin-like growth factor; IV: intravenous; LDL: low-density lipoprotein; LM: lean mass; Lp(a): lipoprotein (a); MTX: methotrexate; NOD: not other defined; PSL: prednisolone; RA: rheumatoid arthritis; RCT: randomized controlled trial; RD: rheumatic diseases; REE: resting energy expenditure; SSZ: sulfasalazine; TBP: total body protein; TC: total cholesterol; TCZ: tocilizumab; TG: triglycerides; TNF: tumor necrosis factor; WC: waist circumference.